Angioedema refers to swelling that occurs in the tissue just below the surface of the skin, most often around the lips and eyes. It generally results from an allergic reaction to either a food or medication. More rarely, it may be a sign of an underlying condition such as leukemia or Hodgkin's disease. In an allergic reaction, the body produces histamine, which causes blood vessels to swell. There are two basic types of angioedema:

• Hereditary angioedema (HAE), which is genetic and tends to recur
• Acquired angioedema (AAE)

Angioedema can take anywhere from minutes to hours to develop. Interestingly, angioedema may affect an area on one side of the body but not on the other. In most cases, angioedema is mild. Severe angioedema can cause the throat or tongue to swell, cutting off the airway, and it can be life-threatening.

Common symptoms of angioedema include:

• Sudden appearance of red welts, especially near the eyes and lips, but also on the hands, feet, and the inside of the throat
• Burning, painful, swollen areas; sometimes itchy
• Hoarseness, tight or swollen throat, breathing trouble
• Discolored patches or rash on the hands, feet, face, or genitals
• Vomiting, abdominal pain, diarrhea, and reduced appetite
• In a form called angioedema-eosinophilia syndrome, hives, itching, fever, muscle pain, decreased urine, weight gain, and high white blood cell count occur.

Sometimes the cause is difficult to identify. An angioedema reaction (AAE in particular) may be caused by allergies to foods, dyes, or pollen, or in reaction to certain medications. Foods that commonly cause allergies include shellfish, dairy, and nuts. Drugs that often spark allergic reactions include nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), blood pressure medication, aspirin, and antibiotics. Conditions such as leukemia, Hodgkin's disease, and connective tissue disorders (such as lupus) may also trigger angioedema.

These factors increase the risk for angioedema:

• Having hives or angioedema before
• Having had a body-wide allergic reaction in the past
• Experiencing injury, sudden temperature change, stress, or anxiety
• Exercising intensely
• Undergoing a dental procedure
• Having ovarian cysts

Your health care provider will perform a physical exam and ask about your symptoms. Be sure to tell him or her about all medications (prescription and over-the-counter), herbs, and supplements you are taking. Blood and urine tests may help pinpoint the cause of the angioedema.

Prevention

You should eliminate any known or suspected triggers. Allergy testing with a trained specialist may help identify inciting agents. If you are prone to angioedema, you should wear a Medic Alert bracelet that notes this condition.

Treatment Plan

The first priority is to ensure that the airway is open and that breathing is not impaired. The next steps include identifying and removing the trigger as well as relieving other symptoms. Infrequent attacks can be managed as they arise. Frequent attacks may require ongoing treatment, perhaps with an allergist, dermatologist, or other specialist to try to avoid recurrences.

Drug Therapies

Several medicines may help prevent or relieve attacks. For mild cases, you can use over-the-counter antihistamines, such as Benadryl, Alavert, or Claritin. Note that Benadryl often causes drowsiness.

You may use prescription antihistamines. For severe cases, your doctor may prescribe corticosteroids to reduce swelling and itching, or you may need a shot of epinephrine. Mild attacks tend to clear up within 4 days with or without medication.

Complementary and Alternative Therapies

In a severe attack, standard emergency medical care should be administered immediately to open airways and stabilize the condition. No new substances, including herbs or supplements, should be introduced during an acute attack.

Long-term nutritional and herbal support used in between attacks may help reduce or prevent angioedema. In addition, herbs and supplements may help alleviate mild symptoms, particularly for chronic and recurring forms. Homeopathic remedies may help alleviate mild symptoms and reduce the frequency and severity of episodes. It is important to tell your doctor about all medications, herbs, and supplements you are taking.

Nutrition and Supplements

Certain foods and food additives may trigger angioedema in people who are susceptible. You should eliminate any foods or food additives that trigger symptoms. The following are the most common food triggers:

• Seafood
• Nuts
• Legumes
• Eggs
• Chocolate
• Milk
• Berries

Certain individuals may have a reaction in response to:

• Citrus fruits
• Sulfites -- used as an antioxidant or freshening agent (preservative) in many foods and beverages
• Yellow dye No. 5 (also called tartrazine) -- those who are allergic to aspirin or other NSAIDs are more susceptible to having an allergy to yellow dye No. 5

Health care providers can help identify food triggers by:

• Collecting detailed information about your diet
• Performing skin tests for sensitivity to certain substances
• Cautiously testing suspected triggers
• Monitoring symptoms as foods are eliminated from your diet, then slowly re-introduced one at a time

If you have gastrointestinal symptoms (abdominal pain, vomiting, diarrhea, or reduced appetite), this may be an indication that you absorb antigens (food triggers) more easily than others through the stomach and intestines. If so, you may benefit from a diet that eliminates common dietary antigens (as listed above) even if you do not have a specific, identifiable food allergy.

These supplements may also help treat symptoms:

• Vitamin C (2 - 4 g per day) may help lower histamine levels. Reduce dose if diarrhea develops.
• Vitamin B12 (1,000 mcg per week by injection) may help reduce the frequency of chronic attacks.
• Quercetin (a naturally occurring flavonoid) may reduce the likelihood of an allergic reaction. The recommended amount is generally 200 - 400 mg three times a day before meals. If you are sensitive to citrus or take calcium-channel blockers to treat high blood pressure, you should avoid citrus-based forms of flavonoids. Quercetin is best absorbed in its water-soluble form, often referred to as hesperidin methyl chalcone (HMC). Few manufacturers make this form, so it can be harder to find. HMC Plus, made by Thorne Research, is one high-quality brand. Others are avialable. Talk to your doctor about which form of quercetin is best for you.
• Bromelain is sometimes used to help reduce inflammation;. You can take it with curcumin (Curcuma longa), the yellow pigment of turmeric, which may enhance its effects. Avoid bromelain if you are allergic to citrus.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea may have antihistamine properties. Drink three cups per day. If caffeine is a problem for you, drink decaffeinated coffee.
• Devil's claw (Harpagophytum procumbens, 2 - 2.5 g per day) may reduce inflammation and skin lesions. Do not take devil's claw if you take blood pressure medication or blood-thinning medication, or if you have diabetes.
• Goldenseal (Hydrastis canadensis, 250 - 500 mg three times per day) has been used for gastrointestinal symptoms such as stomach pain, diarrhea, and reduced appetite that may accompany a severe allergic reaction. Some health care providers also recommend goldenseal for those with food allergies to prevent or lessen reactions
• Licorice root (Glycyrrhiza glabra, 200 - 400 mg 3 times per day) has been used traditionally to lessen inflammation in the case of an allergic reaction. It may also normalize immune function. Do not take licorice if you have heart disease, high blood pressure, or edema.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Apis is traditionally used for hives and angioedema and may be useful to prevent or treat chronic, recurrent cases.

Acupuncture

Some doctors report that acupuncture may help re-establish immune balance and lessen the frequency or severity of allergic reactions such as angioedema.

If angioedema affects the throat, the airway passage could be blocked, thereby creating a life-threatening situation. It is also possible that the angioedema may develop into anaphylaxis, which will require emergency medical care to maintain breathing, blood pressure, and heart function and to reverse the reaction.

After an attack, it's important to identify and avoid any triggers and to treat any underlying condition.

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